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CMS Measure ID:
Version:
8
NQF Number:
0
Performance/Reporting Period
2020
Description:

The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period

Data Elements contained within the eCQM + Expand all

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent durable medical equipment or devices used by frail patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Device.
Inclusion Criteria: Includes only relevant concepts associated with patients that use durable medical equipment or devices for frailty. This is a grouping of HCPCS codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Applied: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.4)

Device, Applied

Data elements that meet criteria using this datatype should document that the device indicated by the QDM category and its corresponding value set is in use, or impacts or alters the treatment, care plan, or encounter (e.g., an antithrombotic device has been placed on the patient's legs to prevent thromboembolism, or a cardiac pacemaker is in place).

Timing: The Relevant Period addresses:

  • startTime – when the device is inserted or first used
  • stopTime – when the device is removed or last used

 

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent durable medical equipment or devices used by frail patients.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Device.
Inclusion Criteria: Includes only relevant concepts associated with patients that use durable medical equipment or devices for frailty. This is a grouping of HCPCS codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Device, Order: Frailty Device value set (2.16.840.1.113883.3.464.1003.118.12.1300)

QDM Datatype and Definition (QDM Version 5.4)

Device, Order

Data elements that meet criteria using this datatype should document an order for the device indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to Advanced Illnesses.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who have an advanced illness diagnosis.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnoses: Advanced Illness value set (2.16.840.1.113883.3.464.1003.110.12.1082)

QDM Attribute and Definition (QDM Version 5.4)

Diagnoses

Coded diagnoses/problems addressed during the encounter. The diagnoses attribute is intended to capture ALL diagnoses, including principal diagnosis. Use of the Encounter, Performed: diagnoses attribute and the Diagnosis datatype is redundant for relating the diagnosis to the Encounter, Performed. The Encounter, Performed: diagnoses syntax is preferred. Referencing the same diagnosis using Encounter, Performed (diagnoses attribute) and Diagnosis (datatype) should only occur if the measure must define a specified length of a prevalence period, e.g., the measure must assure that the diagnoses have been present for at least some defined time period before the encounter, and were addressed during the Encounter.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that identify patients who have a diagnosis of diabetes.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who have type I or type II diabetes.
Exclusion Criteria: Excludes patients who have gestational diabetes or steroid-induced diabetes.

Constrained to codes in the Diagnosis: Diabetes value set (2.16.840.1.113883.3.464.1003.103.12.1001)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a diagnosis of diabetic nephropathy.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with patients who have diabetic nephropathy.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Diabetic Nephropathy value set (2.16.840.1.113883.3.464.1003.109.12.1004)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent diagnoses of frailty.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with diagnoses that represent frailty. This is a grouping of ICD10CM and SNOMEDCT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Frailty Diagnosis value set (2.16.840.1.113883.3.464.1003.113.12.1074)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a diagnosis of glomerulonephritis and nephrotic syndrome.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who are diagnosed with glomerulonephritis and nephrotic syndrome.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Glomerulonephritis and Nephrotic Syndrome value set (2.16.840.1.113883.3.464.1003.109.12.1018)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent hypertensive kidney disease.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with hypertensive kidney disease.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Hypertensive Chronic Kidney Disease value set (2.16.840.1.113883.3.464.1003.109.12.1017)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent kidney failure.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with diagnosis codes to identify kidney failure and kidney disease.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Kidney Failure value set (2.16.840.1.113883.3.464.1003.109.12.1028)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent a diagnosis of proteinuria.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Diagnosis.
Inclusion Criteria: Includes only relevant concepts associated with a diagnosis of proteinuria.
Exclusion Criteria: No exclusions.

Constrained to codes in the Diagnosis: Proteinuria value set (2.16.840.1.113883.3.526.3.1003)

QDM Datatype and Definition (QDM Version 5.4)

Diagnosis

Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships.

Timing: The Prevalence Period references the time from the onset date to the abatement date.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to acute inpatient visits.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an acute inpatient setting. This is a grouping value set of CPT and SNOMED codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Acute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1083)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set grouping contains concepts that represent annual wellness visits.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an annual wellness visit.
Inclusion Criteria: Includes only relevant concepts associated with encounters specific to annual wellness visits.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Annual Wellness Visit value set (2.16.840.1.113883.3.526.3.1240)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients living in assisted living, domiciliary care or rest homes who have had an interaction with a member of their medical team.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with services provided to new and established patients living in assisted living, domiciliary care or rest home. This is a grouping value set of CPT codes.
Exclusion Criteria: Excludes visits in settings other than assisted living, domiciliary care or rest homes.

Constrained to codes in the Encounter, Performed: Care Services in Long-Term Residential Facility value set (2.16.840.1.113883.3.464.1003.101.12.1014)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to an ED visit.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an ED. This is a grouping value set of CPT and SNOMED codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: ED value set (2.16.840.1.113883.3.464.1003.101.12.1085)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent the most common inpatient encounter types.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter. The intent of this data element is to identify patients who have had an inpatient encounter.
Inclusion Criteria: Includes only relevant concepts associated with SNOMED CT codes representing inpatient encounter.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who had ESRD monthly outpatient services.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Encounter.
Inclusion Criteria: Includes only relevant concepts associated with identifying patients who had ESRD monthly outpatients services.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: ESRD Monthly Outpatient Services value set (2.16.840.1.113883.3.464.1003.109.12.1014)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent nursing care services provided to frail patients.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with nursing care and home care services provided to frail patients. This is a grouping of CPT, HCPCS, and SNOMEDCT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Frailty Encounter value set (2.16.840.1.113883.3.464.1003.101.12.1088)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who have had a home health visit by a provider for the evaluation or management of a new or existing patient.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with home visits for the evaluation and management of a new or established patient. This is a grouping value set of CPT and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Home Healthcare Services value set (2.16.840.1.113883.3.464.1003.101.12.1016)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to nonacute inpatient visits.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in a nonacute inpatient setting. This is a grouping value set of CPT and SNOMED codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Nonacute Inpatient value set (2.16.840.1.113883.3.464.1003.101.12.1084)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who have had an interaction with a member of their medical team on admission to a nursing facility.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with services provided to new and established patients in a nursing facility (skilled, intermediate and long-term care facilities).
Exclusion Criteria: Excludes visits in settings other than a nursing facility.

Constrained to codes in the Encounter, Performed: Nursing Facility Visit value set (2.16.840.1.113883.3.464.1003.101.12.1012)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to observation visits.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an observation care setting. This is a grouping value set of CPT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Observation value set (2.16.840.1.113883.3.464.1003.101.12.1086)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who have had an office or other outpatient visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity. This is a grouping value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Office Visit 1 value set (2.16.840.1.113883.3.464.1003.101.12.1001)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts related to outpatient visits.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive history, evaluation, and management of a patient in an outpatient setting. This is a grouping value set of CPT and HCPCS codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Encounter, Performed: Outpatient value set (2.16.840.1.113883.3.464.1003.101.12.1087)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients over the age of 18 who have had an established preventive care office visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual the age of 18 years or over. This is a grouping value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up 1 value set (2.16.840.1.113883.3.464.1003.101.12.1025)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients over the age of 18 who have had an initial preventive care office visit.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Encounter, Performed.
Inclusion Criteria: Includes only relevant concepts associated with comprehensive preventive medicine reevaluation and management of an individual the age of 18 years or over. This is a grouping value set of CPT codes.
Exclusion Criteria: Excludes non-office visits, including telehealth services.

Constrained to codes in the Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up value set (2.16.840.1.113883.3.464.1003.101.12.1023)

QDM Datatype and Definition (QDM Version 5.4)

Encounter, Performed

Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – the time the encounter began (admission time)
  • stopTime – the time the encounter ended (discharge time)

The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained.

The Location Period is an attribute of the attribute facility location addresses:

  • startTime -the time the patient arrived at the location;
  • stopTime -the time the patient departed from the location
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Order or Intervention, Order. The intent of this value set is to identify all patients receiving hospice care outside of a hospital or long term care facility.
Inclusion Criteria: Includes only relevant concepts associated with hospice care concepts.
Exclusion Criteria: Excludes concepts for palliative care or comfort measures.

Constrained to codes in the Intervention, Order: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

QDM Datatype and Definition (QDM Version 5.4)

Intervention, Order

Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set.

Timing: The time the order is signed; Author dateTime

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients received dialysis education.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Intervention, Performed.
Inclusion Criteria: Includes only relevant concepts associated with patients who had dialysis education. This includes only relevant concepts associated with education at home.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Performed: Dialysis Education value set (2.16.840.1.113883.3.464.1003.109.12.1016)

QDM Datatype and Definition (QDM Version 5.4)

Intervention, Performed

Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the intervention begins
  • stopTime – the time the intervention ends

NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients receiving hospice care outside of a hospital or long term care facility.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Order or Intervention, Order. The intent of this value set is to identify all patients receiving hospice care outside of a hospital or long term care facility.
Inclusion Criteria: Includes only relevant concepts associated with hospice care concepts.
Exclusion Criteria: Excludes concepts for palliative care or comfort measures.

Constrained to codes in the Intervention, Performed: Hospice care ambulatory value set (2.16.840.1.113762.1.4.1108.15)

QDM Datatype and Definition (QDM Version 5.4)

Intervention, Performed

Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the intervention begins
  • stopTime – the time the intervention ends

NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent services related to dialysis.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Intervention, Performed.
Inclusion Criteria: Includes only relevant concepts associated with other services related to dialysis.
Exclusion Criteria: No exclusions.

Constrained to codes in the Intervention, Performed: Other Services Related to Dialysis value set (2.16.840.1.113883.3.464.1003.109.12.1015)

QDM Datatype and Definition (QDM Version 5.4)

Intervention, Performed

Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the time the intervention begins
  • stopTime – the time the intervention ends

NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent urine protein tests.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Laboratory Test, Performed.
Inclusion Criteria: Includes only relevant concepts associated with identifying urine protein tests, including those that look for albumin, microalbumin, and protein.
Exclusion Criteria: Excludes codes that identify urine protein tests that would be taken from a fetus.

Constrained to codes in the Laboratory Test, Performed: Urine Protein Tests value set (2.16.840.1.113883.3.464.1003.109.12.1024)

QDM Datatype and Definition (QDM Version 5.4)

Laboratory Test, Performed

Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime – when the laboratory test is initiated (i.e., the time the specimen collection begins)
  • stopTime – when the laboratory test is completed (i.e., the time the specimen collection ends)

Examples:

  • Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – basically a single point in time for many specimen collections
  • Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection

Note – the time that the result report is available is a separate attribute than the time of the study (specimen collection).

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARB) therapies.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with semantic clinical drugs concepts associated with component, form and strength); generic; prescribable; ACE inhibitor, ARB therapy, combination drugs such as ACEI plus diuretic, ARB plus neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic.
Exclusion Criteria: Excludes branded drugs; components or ingredients only; non-prescribable.

Constrained to codes in the Medication, Active: ACE Inhibitor or ARB value set (2.16.840.1.113883.3.526.3.1139)

QDM Datatype and Definition (QDM Version 5.4)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.  

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent dementia medications.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Medication, Ordered.
Inclusion Criteria: Includes semantic clinical drugs (includes component, form and strength); generic; prescribable. Includes dementia medications. This is a grouping of RXNORM codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Medication, Active: Dementia Medications value set (2.16.840.1.113883.3.464.1003.196.12.1510)

QDM Datatype and Definition (QDM Version 5.4)

Medication, Active

Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set is being taken by the patient. Keep in mind that when this datatype is used with timing relationships, the criterion is looking for a medication being taken for the time frame indicated by the timing relationships.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.  

Timing: The Relevant Period addresses:

  • startTime - when the medication is first known to be used (generally the time of entry on the medication list),
  • stopTime - when the medication is discontinued (generally, the time discontinuation is recorded on the medication list)
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARB) therapies.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with semantic clinical drugs concepts associated with component, form and strength); generic; prescribable; ACE inhibitor, ARB therapy, combination drugs such as ACEI plus diuretic, ARB plus neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic.
Exclusion Criteria: Excludes branded drugs; components or ingredients only; non-prescribable.

Constrained to codes in the Medication, Discharge: ACE Inhibitor or ARB value set (2.16.840.1.113883.3.526.3.1139)

QDM Datatype and Definition (QDM Version 5.4)

Medication, Discharge

Data elements that meet criteria using this datatype should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter.

Timing: The time the discharge medication list on the discharge instruction form is authored.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent angiotensin-converting enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARB) therapies.
Data Element Scope: This value set may use Quality Data Model (QDM) category related to Medication.
Inclusion Criteria: Includes only relevant concepts associated with semantic clinical drugs concepts associated with component, form and strength); generic; prescribable; ACE inhibitor, ARB therapy, combination drugs such as ACEI plus diuretic, ARB plus neprilysin inhibitor (ARNI), ARB plus diuretic, ACEI plus calcium channel blocker, ARB plus calcium channel blocker, or ARB plus calcium channel blocker plus diuretic.
Exclusion Criteria: Excludes branded drugs; components or ingredients only; non-prescribable.

Constrained to codes in the Medication, Order: ACE Inhibitor or ARB value set (2.16.840.1.113883.3.526.3.1139)

QDM Datatype and Definition (QDM Version 5.4)

Medication, Order

Data elements that meet criteria using this datatype should document a request to a pharmacy to provide the medication indicated by the QDM category and its corresponding value set.

Timing: The Author dateTime is the time the order is signed.

Timing: The Relevant Period addresses:

  • startTime - when the first administration of the medication is expected. The first administration may be expected at the time of the order or at a specified future date (i.e., the active time for the order); such information should be identified in the medication order. If the startTime is not specified in the order, the startTime defaults to the Author dateTime (the time the order is signed).
  • stopTime - when the medication supply provided by the medication order is expected to be completed, including all fulfillments covered by the number of refills.

Note that when calculating cumulative medication duration, the stopTime may be present directly in the medication order. If the stopTime is not available, the duration in days is the difference between the Relevant Period start and stop times multiplied by (1 + the number of refills).

Direct Reference Code

Constrained to 'Birth date' LOINC code

QDM Datatype and Definition (QDM Version 5.4)

Patient Characteristic Birthdate

The Patient Characteristic Birthdate data element should document the patient’s date of birth. Timing: The Patient Characteristic, Birthdate is a single point in time representing the date and time of birth. It does not have a start and stop time. Note: Patient Characteristic Birthdate is fixed to LOINC code 21112-8 (Birth date) and therefore cannot be further qualified with a value set.

Value Set Description from VSAC
Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

Constrained to codes in the Patient Characteristic, Ethnicity: Ethnicity value set (2.16.840.1.114222.4.11.837)

QDM Datatype and Definition (QDM Version 5.4)

Patient Characteristic Ethnicity

Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set.

Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
Inclusion Criteria: All codes in the code system
Exclusion Criteria: none

Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)

QDM Datatype and Definition (QDM Version 5.4)

Patient Characteristic Payer

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.

Timing: The Relevant Period addresses:

  • startTime – the first day of insurance coverage with the referenced payer
  • stopTime – the last day of insurance coverage with the referenced payer

 

Value Set Description from VSAC
Clinical Focus: n/a Data Element Scope: n/a Inclusion Criteria: n/a Exclusion Criteria: n/a

Constrained to codes in the Patient Characteristic, Race: Race value set (2.16.840.1.114222.4.11.836)

QDM Datatype and Definition (QDM Version 5.4)

Patient Characteristic Race

Data elements that meet criteria using this datatype should document the patient’s race.

Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

Value Set Description from VSAC
Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
Data Element Scope: Gender
Inclusion Criteria: Male and Female only.
Exclusion Criteria: Any gender identity that is not male or female.

Constrained to codes in the Patient Characteristic, Sex: ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

QDM Datatype and Definition (QDM Version 5.4)

Patient Characteristic Sex

Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set.

Timing: Birth (administrative) sex does not have a specific timing.

Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent dialysis services.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure.
Inclusion Criteria: Includes only relevant concepts associated with patients who had dialysis services.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: Dialysis Services value set (2.16.840.1.113883.3.464.1003.109.12.1013)

QDM Datatype and Definition (QDM Version 5.4)

Procedure, Performed

Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent patients who have undergone kidney transplant.
Data Element Scope: This value set may use the Quality Data Model (QDM) category related to Procedure.
Inclusion Criteria: Includes only relevant concepts associated with kidney transplants.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: Kidney Transplant value set (2.16.840.1.113883.3.464.1003.109.12.1012)

QDM Datatype and Definition (QDM Version 5.4)

Procedure, Performed

Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent procedures related to accessing the vascular system for dialysis.
Data Element Scope: This value set may use the Quality Data Model (QDM) datatype related to Procedure, Performed.
Inclusion Criteria: Includes only relevant concepts associated with procedures related to accessing the vascular system for dialysis such as inserting a needle or catheter or creating a shunt. This is a grouping of CPT and SNOMED CT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Procedure, Performed: Vascular Access for Dialysis value set (2.16.840.1.113883.3.464.1003.109.12.1011)

QDM Datatype and Definition (QDM Version 5.4)

Procedure, Performed

Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set.

A QDM Known Issue has been identified related to this datatype. To see this QDM known Issue, please click here.

Timing: The Relevant Period addresses:

  • startTime -the time the procedure begins,
  • stopTime -the time the procedure is completed

NOTE:

  1. Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request.
  2. The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.
Value Set Description from VSAC
Clinical Focus: This value set contains concepts that represent frailty symptoms.
Data Element Scope: This value set may use Quality Data Model (QDM) datatype related to Symptom.
Inclusion Criteria: Includes only relevant concepts associated with frailty symptoms. This is a grouping of ICD10CM and SNOMEDCT codes.
Exclusion Criteria: No exclusions.

Constrained to codes in the Symptom: Frailty Symptom value set (2.16.840.1.113883.3.464.1003.113.12.1075)

QDM Datatype and Definition (QDM Version 5.4)

Symptom

Symptom represents an indication that a person has a condition or disease. Some examples are headache, fever, fatigue, nausea, vomiting, and pain. Also, symptoms are subjective manifestations of the disease perceived by the patient. As an example to differentiate symptom from finding, the patient’s subjective symptom of fever is distinguished from the temperature (a finding). For a finding, there is either a source of either a temperature-measuring device together with a recorder of the device (electronically) or an individual (healthcare provider, patient, etc.).